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Ask the Experts: How Do We Control and Prevent Malaria?

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Malaria is a serious disease of the blood that is caused by a parasite and transmitted to humans through mosquitos. Although malaria can deadly, there are treatments available for those infected and medications that prevent infection.

Key Highlights

Malaria is not as prevalent in the United States or Europe but is extremely prevalent in many underserved areas such as those located within the “Mosquito Belt,” which runs along the Earth’s equator.

Malaria is not as prevalent in the United States or Europe, but is extremely prevalent in many underserved areas such as those located within the “Mosquito Belt,” which runs along the Earth’s equator.

In advance of World Malaria Day, we spoke with Darin Seehafer, Director of Therapeutic Expertise, from PRA’s Center for Vaccine Research, and the Center’s interning physicians completing the University of Siena’s Master of Vaccinology Program, Keiko Pempho Msusa and Nginache Victoria Nampota.

What is the status of malaria and its treatments across the world today?

Darin:There are four kinds of parasites that infect humans with malaria. Symptoms of malaria are quite similar to the flu, and mainly involve high fevers and chills.

Historically, the “Mosquito Belt,” which is located along the equator, is where malaria is most prevalent. Because of global warming, mosquitos are migrating beyond this region to areas typically not affected by the disease. We’re seeing an increase in new infections and the expansion of the belt, which has also led to the spread of zika and some mosquito-borne illnesses in the United States.

Within a country, there are regions with higher rates of malaria infections that differ due to altitude and topography. For example, there are more mosquitos in rainforest areas than in urban areas.

There are four kinds of parasites that infect humans with malaria. Symptoms of malaria are quite similar to the flu, and mainly involve high fevers and chills.

Darin Seehafer, Director of Therapeutic Expertise

How are people who don’t have easy access to healthcare diagnosed with and treated for malaria?

Keiko:Where we are in Malawi, when patients present with a fever and headache, a rapid diagnostic test for malaria is conducted most of the time. In certain rural areas with limited resources, it is common to presumptively treat for malaria. It’s the first thing that most physicians will test for here because malaria is so common.

Nginache:I agree with Keiko. In Malawi, it’s assumed malaria until proven otherwise. It’s so common that even when you tell a patient they don’t have malaria, they don’t believe you!

How is awareness raised for malaria?

Keiko:Here, we have the President’s Malaria Initiative, which is done in collaboration with USAID. This initiative largely targets pregnant women or women of a reproductive age. When they attend antenatal or prenatal clinics, respectively, the attending doctor talks to them about malaria and will provide free insecticide treated mosquito nets. Nets are a common prevention tool used to reduce the incidence of infection.

When you move around town, there are messages about the prevention of malaria everywhere—on billboards and posters. Additionally, in radio advertisements, you’ll hear about malaria and its preventative measures due to the fact that it’s so common. They advise to sleep under insecticide treated mosquito nets, and that one should go to the hospital if experiencing any symptoms. While the messaging is everywhere, there is evidence to suggest that these preventative strategies are not often followed. According to the most recent (2015-2016) national demographic health survey, malaria still accounts for approximately 36% of all outpatient visits across all age groups.

Nginache:Malaria is something everyone expects to have in Malawi—we are all aware of the disease and the complications. What people lack is a strong understanding of preventative measures.

There are also large awareness events in communities. For example, there will be a big football match, a concert, or a play of some sort that happens in the communities that the Ministry of Health have targeted as high-risk areas. There’s music, there’s food, and there’s entertainment, so more people gather and see the malaria messaging through that entertainment.

Darin:It is common to see social outreach programs in countries where malaria is most prevalent. In underserved parts of the world, medical professionals have to physically get out there and speak the message, because not everyone has access to internet and technology.

Malawi is a perfect example of how social outreach is embedded into their culture. There’s definitely awareness, but when you don’t have a vaccine, prevention becomes a part of life. This is why the mosquito net initiative is so important. Mosquitos that bite at night transmit the disease. The more nets they get out in these highly endemic areas, the more that they can cut down on all mosquito-borne illnesses.

These countries also have dengue, yellow fever, and tuberculosis awareness programs because those are all prevalent and they have to be talked about in the population.

In the US, awareness for diseases like malaria is directed to travelers, so you’ll receive that information through travel clinics and primary care physicians. They’ll tell you what you what diseases are concerns in the countries you are traveling to and what vaccines are needed for entry. For example, if you are traveling to a country with high malaria incidences, you will be given an anti-malaria tablet to in advance of your trip or after your return.

Nginache:Mosquito nets are a key part of prevention. Malawi has specific groups that are targeted for malaria awareness, malaria prevention awareness, and mosquito net distribution. One group that receives chemoprophylaxis (the use of drugs to prevent disease) is comprised of pregnant women. They take pills every couple of months and they receive mosquito nets to use until their baby is at least 5 years old. Another group that Malawi focuses on for chemoprophylaxis is the HIV-positive population. They receive a drug that prevents malaria as well as other infectious diseases. These interventions usually work very well.

A common problem we face is that some people don’t see the benefit of nets. Instead of using the nets to protect against malaria, they use the nets for fishing or use them to cover their trees so birds don’t eat them. Their uptake of nets and therefore the impact of nets is not so great, especially in those areas. There are awareness campaigns going on to prevent their misuse, but they need more work.

Malaria is something everyone expects to have in Malawi—we are all aware of the disease and the complications. What people lack is a strong understanding of preventative measures.

Nginache Victoria Nampota

What makes it difficult to get a vaccine for malaria? What variables need to be tackled?

Darin:One of the biggest problems you have with any vaccine is overall use. In order for a potential malaria vaccine to really be effective and to impact the population, you need to have uptake. Unfortunately, the “Mosquito Belt” has some of the most underserved populations on the planet. Therefore, uptake will definitely be an issue. It would require mass vaccine campaigns to really impact the spread.

The cost to develop a vaccine vs. the ability to recoup that cost is a bit prohibitive, just as it was with dengue fever. You have to create a vaccine that might work for maybe just one malaria type initially, or all four.

There also hasn’t been a good study of the disease as it pertains to humans—the mechanisms and modes of action.

There are some interesting studies going on right now, including one by a company called SEEK Group—they’re working on an anti-mosquito vaccine. This vaccine is designed to provide an immune reaction to the proteins in the mosquito saliva which may stop the mosquito from transferring virus when it bites.

With this vaccine, once you’re bitten, the mosquito’s feeding tube becomes clogged. The mosquito essentially can’t regurgitate their meal into your arm, thereby not rinsing the bacteria in their gut into your body. This prevents you from getting malaria, dengue, or any other mosquito-borne illness. It also kills off the mosquito.

When you start to think about vaccinating against malaria, you almost want a more holistic approach. There are so many mosquito-borne illnesses, including dengue, zika, and West Nile.

Keiko:I’ll just echo what Darin is saying. The environment and the economic conditions of the countries most effected by malaria don’t yield much hope for achieving “eradication” in the future.

The parasite is complex and so is the interplay between the parasite biology and the host immunity. Combined with a lack of adequate resources and lack of effective global cooperation, the development of a malaria vaccine is taking a long time. You can’t make a vaccine for one mosquito-borne illness without taking into consideration the other illnesses.

Darin:All of those mosquito-borne illnesses that compete for those same resources as far as development. They’re all in areas where return on investment for most pharmaceutical companies is relatively low. So pharmaceutical companies aren’t incentivized to go out and spend the money that’s needed. You need groups like the Gates Foundation and the World Health Organization to fund private and public partnerships for that research.